Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Tommy Souriyavong, ATC, LAT

Individual provider Athletic Trainer · NPI 1477487221

Tommy Souriyavong, ATC, LAT is an Athletic Trainer in Old Forge, Pennsylvania. Registered with an NPI since 2026.

In the registry since
2026
What do these letters mean?
ATC — Certified Athletic Trainer
Prevents and treats sport and activity injuries.
LAT — Licensed Athletic Trainer
A state-licensed athletic trainer.

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Practice location Address checks out

110 Bubernak Blvd
Old Forge, PA 18518-1021
Phone: (570) 540-1178
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Athletic Trainer (primary) Taxonomy 2255A2300X

Record details

NPI number1477487221
Entity typeIndividual (Type 1)
GenderMale
Credentials ATC , LAT
Sole proprietorNo
NPI enumeratedJune 9, 2026
Last updated in NPPESJune 9, 2026
Certification dateJune 9, 2026

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